This study was designed to compare the efficacy of transcatheter arterial embolization (TAE) with
N-butyl cyanoacrylate (NBCA) or
gelatin sponge particles (GSP) for acute arterial
bleeding in a coagulopathic condition using a swine model. Four healthy swine were divided into two coagulopathic conditions: mild and severe. Five
hemorrhages were created in each swine (10
hemorrhages per coagulopathy). Mild coagulopathy was achieved by
bloodletting 10% of the total circulatory whole blood and preserving activated clotting time (ACT) less than 200 s (ACT < 200 s state); severe coagulopathy was achieved by
bloodletting 30% and preserving ACT > 400 s (ACT > 400-second state). For each state, of ACT < 200 s or ACT > 400 s, TAE was conducted with GSP or NBCA to control five
hemorrhages arising from artificially created renal and splenic
injuries. Angiography immediately after TAE with GSP or NBCA showed complete occlusion in both coagulopathic conditions. In the ACT < 200-second state, follow-up angiography at 5-30 min after TAE with GSP or NBCA showed no evidence of recurrent
hemorrhage. In the ACT > 400-second state, follow-up angiography showed recurrent
hemorrhage in four (80%) of the five
hemorrhages embolized with GSP and in one (20%) of the five
hemorrhages embolized with NBCA. Microscopically, red thrombi were observed densely surrounding GSP in mild coagulopathy but were scarce in severe coagulopathy. In a condition with severe coagulopathy, TAE with NBCA was more effective in durability to cease active arterial
bleeding than with GSP.